Meningococcal disease

What

Meningococcal disease is caused by the bacterium Neisseria meningitidis. The bacterium is commonly known as meningococcus.

There are 13 known meningococcal serogroups, distinguished by differences in surface polysaccharides of the bacterium’s outer membrane capsule. Globally, serogroups A, B, C, W and Y most commonly cause disease. 

Invasive meningococcal disease (IMD) is a rare but serious disease. It most commonly presents as septicaemia and/or meningitis.

Who

Meningococcal vaccines are recommended for:

• infants, children, adolescents and young adults
• special risk groups, including Aboriginal and Torres Strait Islander people, individuals with certain medical conditions (see List. Specified medical conditions associated with increased risk of invasive meningococcal disease), laboratory workers who frequently handle Neisseria meningitidis, travellers, and young adults who live in close quarters or who are current smokers

How

Several vaccines are available in Australia to reduce the risk of meningococcal disease. However, no single vaccine protects against all serogroups: 

• 2 vaccines protect against meningococcal serogroup B — MenB vaccines.
• 2 vaccines protect against meningococcal serogroup C only — MenC vaccine and Hib-MenC vaccine (combined with Haemophilus influenzae type b).
• 3 vaccines protect against meningococcal serogroups A, C, W and Y — MenACWY (quadrivalent) conjugate vaccines.

Why

Although it is rare, IMD is a serious infection that can cause significant illness, disability and death. Vaccination programs have successfully reduced the incidence of IMD caused by serogroup C. The incidence of IMD caused by serogroups W and Y increased from 2013 and 2015, respectively.
However, the incidence of meningococcal W disease has fallen since state vaccination programs with MenACWY vaccine were introduced in 2017 and subsequently incorporated onto the National Immunisation Program. IMD caused by serogroup B continues to occur in Australia.

See

• Infographic. Meningococcal vaccination for children and adolescents without risk factors
• Infographic. Meningococcal vaccination for people in a special risk group

Meningococcal vaccines available in Australia

The Therapeutic Goods Administration website provides product information for each vaccine.

See also Vaccine information and Variations from product information for more details.

Dose and route

The dose of all meningococcal vaccines is 0.5 mL given by intramuscular injection. Co-administration with other vaccines

Co-administration with other vaccines

MenACWY vaccines

MenACWY vaccines can be co-administered with most other vaccines.

MenACWY vaccines are safe to use with most other vaccines given in childhood^11-21 and adolescence.^22-26 In most studies, the frequency of reactions after vaccination was similar regardless of whether the vaccines were received together or separately. Some studies showed slight increases in mild reactions when vaccines were given together.

If a person needs to receive Nimenrix and a vaccine containing tetanus toxoid (such as Infanrix hexa or Vaxelis), co-administration of these vaccines is preferred. Giving Nimenrix after a vaccine containing tetanus toxoid may interfere with the immune response against some meningococcal serogroups. There is uncertainty about whether this reduced immune response affects clinical protection, and there are no data on the optimal interval between the vaccines. Therefore, Nimenrix should be given as scheduled, even if it is being given shortly after a vaccine containing tetanus toxoid.

MenB and MenACWY vaccines can be co-administered at any age. Clinical studies for concomitant use of MenB vaccines with MenACWY vaccines show non-inferior immune responses and tolerable safety profiles.^27-30

MenB vaccines

Bexsero can be safely given with other routine vaccines.

Children <2 years of age have an increased risk of fever if Bexsero is co-administered with other routine vaccines, compared with when these vaccines are given separately (see Adverse events).

However, this is not a contraindication to co-administration of Bexsero with other vaccines. Children <2 years of age are recommended to receive prophylactic paracetamol if they are receiving Bexsero at the same time as other routinely scheduled vaccines. See Contraindications and precautions.

Children <2 years of age can receive Bexsero separately from other routine infant vaccines, with a minimum interval of 3 days, to minimise the risk of fever. In this case, give routinely recommended vaccines first.

Adolescents can safely receive Trumenba at the same time as other vaccines given in adolescence, including HPV (human papillomavirus) vaccine³¹ and dTpa (reduced antigen content diphtheria-tetanus-acellular pertussis) vaccines.³⁰

MenB and MenACWY vaccines can be co-administered at any age.

Interchangeability of meningococcal vaccines

MenACWY vaccines

If possible, complete the primary course of MenACWY vaccination with the same vaccine brand. If this is not possible, use an alternative brand following the dose recommendations by age. See Recommended dose schedules.

People can receive booster doses using any brand of of MenACWY vaccine.

MenB vaccines

Bexsero (MenB-MC) and Trumenba (MenB-fHBP) are not interchangeable. The same vaccine should be used for all primary vaccine doses as well as any booster.

If an infant or child <10 years of age is inadvertently given a booster dose of Trumenba, repeat the dose with Bexsero. If a person ≥10 years of age receives a booster dose that is a different brand to the primary course, they do not need an extra or repeat dose of the booster vaccine. While it is not preferable as there is no specific data on interchangeability of Bexsero and Trumenba, it will still provide protection.

Contraindications

The only absolute contraindications to meningococcal vaccines are:

• anaphylaxis after a previous dose of any meningococcal vaccine
• anaphylaxis after any component of a meningococcal vaccine

Previous meningococcal disease, regardless of the serogroup, is not a contraindication to receiving any meningococcal vaccine.

Previous vaccination with the strain-specific MenB vaccine used in New Zealand (MeNZB) is not a contraindication to receiving either Bexsero or Trumenba.

Previous vaccination with a quadrivalent polysaccharide meningococcal vaccine (4vMenPV; previously available in Australia but now discontinued) is not a contraindication to receiving any MenACWY vaccine. See ‘People who have previously received a meningococcal polysaccharide vaccine’ in Laboratory workers or Travellers.

Precautions

Prophylactic administration of paracetamol with Bexsero vaccination in children aged <2 years

Children <2 years of age are recommended to receive prophylactic paracetamol with every dose of Bexsero. This is because of the increased risk of fever, including high fever, after receiving Bexsero^32,33 (see Adverse events). This is an exception to the general recommendation to not routinely give paracetamol at the time of vaccination (see Adverse events following immunisation).

The 1st dose of paracetamol (15 mg/kg/dose) is recommended within 30 minutes before, or as soon as practicable after, receiving the vaccine. This is regardless of whether the child has a fever. This can be followed by 2 more doses of paracetamol given 6 hours apart, regardless of whether the child has a fever.

A clinical trial showed that using paracetamol prophylactically in infants reduced the likelihood of high-grade fever by about half after any vaccine dose. This had no overall impact on the immune responses to either Bexsero or other vaccines given at the same time.³⁴

Similarly, prophylactic antipyretics reduced the likelihood of fever in the first 48 hours after the 1st dose of Bexsero by about 50% among more than 1500 children <2 years of age.³⁵ This was seen in a population-based MenB vaccination program using Bexsero in a region of Quebec, Canada (see Adverse events).

Women who are pregnant or breastfeeding

Meningococcal vaccines are not recommended for pregnant or breastfeeding women,^36,37 except in special rare circumstances. See Vaccination for women who are planning pregnancy, pregnant or breastfeeding.

People with latex allergy

The product information for Menveo states that the tip cap of the syringe contains natural rubber. The risk of allergy is lower from natural rubber than from latex. However, consider using an alternative product in people with an allergy or sensitivity to latex.

MenACWY vaccines

Meningococcal ACWY vaccines have been shown to be safe in multiple clinical trials and large population studies (conducted in countries after the vaccines became available) in people of different ages, from infants to adults.^11-15,38-48 Most reactions after vaccination are mild and resolve on their own. Meningococcal ACWY vaccines are safe for use in people with HIV.^49,50

Meningococcal ACWY vaccines can be safely administered at the same time as other routine vaccines provided to young children through the National Immunisation Program. In most studies, the frequency of reactions after vaccination was similar regardless of whether the vaccines were given together or separately. Some studies showed slight increases in mild reactions when vaccines were given together.

Meningococcal conjugate vaccines are not associated with Guillain–Barré syndrome (GBS).

MenQuadfi

Clinical trials do not show any safety concerns for use of MenQuadfi in infants, children, adolescents or adults.^51-56

In infants 12–23 months of age, 9.6% of trial participants reported fever.^51-56 In children 2–9 years of age, 1.9% of trial participants reported fever.⁵³ Most reactions were mild injection site reactions, which occurred in 39–41% of participants.

A study in adolescents and adults showed that most reactions were mild.⁵⁴ The most common adverse events were:

• pain at the injection site (39% of participants)
• myalgia (32%)
• headache (28%)

About 1% of vaccine recipients reported fever.

Studies of concomitant administration in children⁵² and adolescents⁵⁵ showed that MenQuadfi can be safely co-administered with other routine vaccines. In infants aged 12–23 months, a slightly higher frequency of adverse events was observed when MenQuadfi was co-administered with 13vPCV (13-valent pneumococcal conjugate vaccine).⁵² In children and adolescents aged 10–17 years, a slightly higher frequency of adverse events was observed when MenQuadfi was co-administered with dTpa and HPV vaccines.⁵⁵

Menveo

Clinical trials have shown that Menveo is safe to use in infants, children and adolescents. Most adverse events are mild or moderate. Frequencies of any adverse event and of serious adverse events are similar to those reported for other routine childhood vaccines.^12-15,44-46

In infants and children <2 years of age, 3–23% of trial participants reported fever.^14,15,44-46

A large study in adolescents showed that most reactions were mild. The most common adverse events were:⁵⁷

• pain at the injection site (44% of participants)
• headaches (29%) 
• myalgia (19%) 
• erythema (15%)

About 1% of vaccine recipients reported fever.

The frequency of adverse events did not increase when Menveo was administered with other routine vaccines in infants and young children^12-15,44 or adolescents.²² A slightly higher frequency of adverse events was observed when Menveo was co-administered with both HPV and dTpa vaccines in adolescents.

A large post-licensure safety study of adolescent vaccine recipients found a slightly higher risk of Bell’s palsy in vaccine recipients.⁴⁷ However, ongoing analysis of millions of people who received the vaccine did not find any safety signals for facial paresis.

Nimenrix

Clinical trials have shown Nimenrix to be safe for use in infants, children and adolescents.^{11,17,18,23,40-43} Most reactions were mild injection site reactions, which occurred in 30–50% of vaccine recipients. About one-fifth of people who were vaccinated had a mild systemic reaction.

In young children aged 12–23 months, the frequency of mild adverse events was slightly higher when Nimenrix was administered together with other routine childhood vaccines, particularly Infanrix hexa and Vaxelis.^17,18 Studies on co-administration in adolescents did not show any difference in the frequency of adverse events between administration groups.²³

MenB vaccines

Bexsero

Bexsero has an acceptable safety and tolerability profile based on clinical trial data.

In clinical trials, fever was the most notable systemic reaction in infants and young children, particularly those aged 2–12 months. Temperatures were highest 6 hours after vaccination, then decreased on day 2 and generally subsided by day 3.³² More than a quarter (26–41% depending on dose number) of infants who received Bexsero alone developed fever ≥38°C, and 4–8% had fever ≥39°C.³³

In response to a community epidemic in Quebec, Canada, around 44,000 individuals between 2 months and 20 years of age received at least 1 dose of Bexsero. About 15% (112/746) of infants who participated in the vaccine safety surveillance reported fever. Among 112 infants who reported fever, around 26% reported a peak temperature of 39–40.4°C. <1% reported a peak temperature of ≥40.5°C.³⁵

Safety surveillance (from September 2015 to 31 May 2017) of a national routine vaccination program for children aged 2–18 months using Bexsero in the United Kingdom found no unexpected adverse reactions except for reports that described a local reaction with a persistent nodule at the site of injection, usually without other symptoms.⁶⁴ There was no increase in the frequency of febrile seizures or convulsions in infants who received Bexsero.⁶⁵ A later study showed a small but significantly increased risk of febrile seizures in infants aged 1–18 months who received Bexsero in the United Kingdom from 2015 to 2018.⁶⁶ However, it was difficult to attribute the risk directly to Bexsero as the majority of infants receiving Bexsero (93%) also received other vaccinations on the same day.

In a clinical trial, the frequency of fever was about 2 times higher when infants received Bexsero with other infant vaccines, specifically DTPa-hepB-IPV-Hib vaccine and 7vPCV (7-valent pneumococcal conjugate vaccine). 51–62% of these infants reported fever ≥38°C, and 10–15% reported fever ≥39°C within 7 days of any vaccine dose.³³

Prophylactic paracetamol reduced fever in infants who received Bexsero at the same time as other routine infant vaccines.³⁴ (See also Contraindications and precautions.) In clinical studies, fever and other systemic reactions were less common after a subsequent dose of Bexsero received at 12 months of age.

Other common adverse events after receiving Bexsero included:³²

• tenderness, swelling, induration and erythema at the injection site
• irritability
• sleepiness
• unusual crying
• change in appetite

These reactions were reported less often with increasing age.

Adolescents and adults most commonly reported:⁶⁷

• pain at the injection site
• malaise
• headache

Observational studies on booster doses of Bexsero showed that adverse events occurred at rates similar to those following primary vaccination and were generally mild to moderate.^68-74

Trumenba

Several studies report safety and tolerability for Trumenba.^75-78 There was no significant increase in serious adverse events among more than 4250 people aged 10–25 years who received at least 1 dose of Trumenba.

The most common adverse reactions in these studies were:

• pain at the injection site (≥85%)
• fatigue (≥40%)
• headache (≥35%)
• myalgia (≥30%)
• chills (≥15%)

Most reactions were mild to moderate in severity and did not increase with subsequent doses of Trumenba. The safety profiles were similar for the 3-dose and 2-dose schedules.

One observational study on booster doses of Trumenba showed that adverse events occurred at rates similar to those following primary vaccination and were generally mild to moderate.⁷⁹

MenC vaccines

NeisVac-C

Data from clinical trials in England showed that transient headache of mild to moderate severity was the most commonly reported adverse event. This was more common in older adolescents than in younger children in primary school.⁸⁰

Most local reactions were pain or redness at the injection site. These were mostly mild and resolved on their own.

Post-licensure passive safety surveillance data from the United Kingdom showed that the most commonly reported adverse events were:^81-84

• transient headache
• fever
• local reactions
• dizziness

Meningococcal disease is caused by the bacterium Neisseria meningitidis. The bacterium is commonly known as meningococcus.

There are 13 known meningococcal serogroups, distinguished by differences in surface polysaccharides of the bacterium’s outer membrane capsule. Globally, serogroups A, B, C, W and Y most commonly cause disease.

Pathogenesis

Humans are the only reservoir of Neisseria meningitidis.

Some people carry N. meningitidis without developing disease. The prevalence and duration of asymptomatic nasopharyngeal carriage of meningococcus vary over time, and in different populations and age groups. Prevalence of carriage is higher when groups of people occupy small areas of living space.^85,86

The incubation period is between 2 and 10 days, but commonly 3–4 days.⁸⁷

People at increased risk of invasive meningococcal disease

Some medical conditions increase a person’s risk of developing invasive meningococcal disease (IMD). The magnitude of the risk varies with the primary underlying condition.

People with a complement deficiency have up to a 10,000-fold increased risk of meningococcal disease, depending on the specific condition. People with a complement deficiency are also more likely to become infected again.^88-93

People with an absent or dysfunctional spleen have a lifelong increased risk of severe bacterial infection,^94,95 including meningococcal sepsis.

Other immunocompromising conditions that increase the risk of IMD include HIV^96,97 and haematopoietic stem cell transplant.

Other people at greater risk of meningococcal infection include:

• laboratory workers who handle meningococcus
• new military recruits^6,98
• university students living in residential colleges (particularly in their 1st year)^5,7,99,100
• smokers^10,86

A person’s risk of acquiring meningococcal disease can also increase by:^{10,85,86,101-103}

• exposure to cigarette smoke and being a smoker (due to higher rates of carrying meningococcus)
• intimate kissing with multiple partners
• recent or current viral infection of the upper respiratory tract

There is no definitive evidence that there is an increased risk of IMD among men who have sex with men. However, clusters or community outbreaks of serogroup C IMD among men who have sex with men have been reported.^104-108 

Transmission

Meningococcus is transmitted via droplets or direct contact.⁸⁷

Symptoms of meningococcal disease

Neisseria meningitidis can cause invasive meningococcal disease (IMD), which usually presents as meningitis and septicaemia. Septicaemia, either on its own or with meningitis, can be particularly severe.^87,101

The clinical manifestations of meningococcal septicaemia and meningitis may be non-specific.They can include:¹⁰¹

• sudden onset of fever
• rash (petechial, purpuric or maculopapular)
• headache
• neck stiffness
• photophobia
• altered consciousness
• muscle ache
• cold hands
• thirst
• joint pain
• nausea
• vomiting

Not all symptoms or signs may be present at disease onset.

The characteristic rash of meningococcal disease does not disappear with gentle pressure on the skin, but the rash is not always present.

N. meningitidis can also cause other localised infections, although these are less common, including:^86,100

• septic arthritis
• pneumonia
• epiglottitis
• conjunctivitis

These less common presentations are more common among certain serogroups, especially serogroup W.

Complications of meningococcal disease

Meningococcal infections can progress rapidly to serious disease or death in previously healthy people. The overall mortality risk for IMD is high (5–10%), even if the person receives appropriate antibiotic therapy.

Around one-third of children and adolescents who survive IMD develop permanent complications. These can include:¹⁰¹ 

• limb deformity
• skin scarring
• deafness
• neurologic deficits

Around 30–40% of people who survive IMD have long-term consequences or disabilities. Patients and caregivers can also have psychological symptoms due to these complications.^109-111

Meningococcal disease in Australia

Meningococcal disease can occur sporadically or in epidemics. In Australia, most cases occur during winter and early spring. Other countries with temperate climates also have this seasonal trend.¹¹²

The meningococcal serogroups that cause meningococcal disease have changed over time. A meningococcal C vaccine was introduced on the National Immunisation Program in 2003 and has resulted in a large reduction in meningococcal C disease incidence.^112,113

From 2013, the incidence of meningococcal W disease increased rapidly and the incidence of meningococcal Y disease increased steadily from 2015.¹¹⁴ Several states and territories introduced vaccination programs with MenACWY vaccine in 2017 to manage this disease. MenACWY vaccine was introduced on the National Immunisation Program in 2018 for toddlers aged 12 months, and in 2019 for adolescents. The incidence of meningococcal W disease have fallen with widespread use of the MenACWY vaccine in these age groups.^114,115

Meningococcal B continues to cause most meningococcal disease in Australia.¹¹³

A state-funded MenB vaccination program was introduced in South Australia from 2018. Refer to the South Australian Health Department website for further details. There has been a reduction in meningococcal B disease in South Australia since this vaccination program began.^117,118

Risk by age group, and by Aboriginal and Torres Strait Islander status

Children aged <2 years

Children aged <2 years have the highest incidence of meningococcal cases. The disease occurs most often in infants aged 3–5 months.

Adolescents aged 15–19 years

A high number of meningococcal disease cases occurs among adolescents and young adults aged 15–24 years, with peak rates of disease occurring in 18–20-year-olds. Adolescents and young adults have the highest rate of meningococcal carriage and are thought to play an important role in transmitting the bacteria in a community.⁴

Adolescents and young adults in this age bracket who have a higher risk of acquiring the meningococcal bacteria are:

• people who live in close quarters, such as new military recruits and students living in residential accommodation
• people who have prolonged contact with a person who is carrying meningococcal bacteria^5-7
• people who are smokers^8-10 

Aboriginal and/or Torres Strait Islander people

Aboriginal and Torres Strait Islander people have much higher incidence rates of meningococcal disease than non-Indigenous Australians.¹¹³ This is particularly among children aged <15 years for the 2 most common meningococcal serogroups: B and W.^{112,115,121,122}

Between 2006 and 2015, rates of meningococcal disease caused by serogroup B disease were reported as being 3.4 times and 3.8 times higher among Aboriginal and Torres Strait Islander infants aged <12 months and children aged 1–4 years, respectively, compared with non-Indigenous infants and children of the same age.¹¹³

Invasive meningococcal disease (IMD) is a rare condition. Because of this, studies to assess the effectiveness of a vaccine in preventing IMD are not feasible because very large numbers of people would need to be vaccinated and followed up over long periods of time.

As an alternative, studies measure the immune response to meningococcal vaccines, which indicates how effective the vaccine is likely to be. An immune response is considered to have occurred if antibodies are detected above a standard threshold that is likely to be protective against the disease.

Meningococcal B vaccines

Bexsero (MenB-MC)

Bexsero induces bactericidal antibodies specific to the 4 vaccine antigens in infants, children, adolescents and younger adults. Antibody levels correlate with protection against clinical disease.^{29,30,59,102,103}

Bexsero is expected to protect against most circulating meningococcal B strains. Specialised laboratory testing (Meningococcal Antigen Typing System, or MATS) has predicted that around 75% of all meningococcal B strains that caused disease in Australia from 2007 to 2011 would have been susceptible to effective killing by vaccine-induced antibodies.¹⁰⁵

Data on vaccine effectiveness are available from the United Kingdom, where a routine infant program using a reduced dosing schedule was introduced in 2015. The vaccine effectiveness of 2 doses given at 2 and 4 months of age was 82.9%.¹⁰⁵

Studies on booster doses of Bexsero in healthy people show that a booster dose has a moderate effect on protective immune responses.^68-74

Trumenba (MenB-fHBP)

People aged 11–18 years show good immune responses after receiving 2 doses of Trumenba 6 months apart. They also show good immune responses after receiving 3-dose schedule of Trumenba at 0, 1–2 and 6 months.⁷⁶ 

Protective immune responses were seen in: 

• 82–83% of trial participants after 3 doses received at 0, 1 and 6 months, or 0, 2 and 6 months 
• 73.5% of participants after 2 doses received at 0 and 6 months

Several clinical trials in people aged 10–25 years have also shown that both 3-dose and 2-dose schedules are safe and can be administered with other vaccines.^75-78,124

Studies on booster doses of Trumenba in healthy people show that a booster dose has a moderate effect on protective immune responses.⁷⁹

Meningococcal conjugate vaccines

Conjugate meningococcal vaccine formulations contain meningococcal serogroup antigens that are joined (conjugated) to a carrier protein. Because each of the 3 MenACWY vaccines contains different conjugate carrier proteins, they produce different levels of immune response. It is not known whether these differences affect a person’s protection against meningococcal disease. However, a stronger immune response, measured by antibody levels, is likely to predict better protection against the disease.

MenQuadfi (MenACWY-TT)

MenQuadfi induces an immune response against serogroups A, C, W and Y after a single dose in infants 12–23 months of age,^51,52,55 children 2–9 years of age,53 and adolescents and adults aged ≥10 years. ^54-56

Among infants aged 12–23 months, seroprotection was high (84–99%) for all serogroups⁵¹ after vaccination with MenQuadfi. Similarly, when MenQuadfi was co-administered with routine vaccines, seroprotection was 89–100% for all serogroups.⁵²

Children aged 2–9 years who received MenQuadfi produced a good immune response after a single dose. More than 85% of children developed protection against all 4 serogroups.

Seroprotection induced by MenQuadfi in adolescents and adults has been assessed in a number of studies.^54-56 All clinical trials found that MenQuadfi produced an immune response against all serogroups. Co-administration of MenQuadfi with dTpa and HPV vaccines to adolescents aged 10–17 years produced similar antibody responses to those produced when MenQuadfi was administered alone.⁵⁵

Menveo (MenACWY-CRM)

Menveo is safe to use in children from 2 months of age.^12-14,44 When given in a 3-dose schedule at 2, 4 and 12 months of age, more than 99% of children in a clinical trial developed protection against meningococcal W and Y after they completed the course.¹⁴

For children who start vaccination at age 6 months to <12 months, a 2-dose schedule with Menveo produces a good immune response. In a large study with more than 1600 participants, more than 96% of children who received 2 doses of Menveo at age 7–9 months and 12 months developed protection against meningococcal C, W and Y.¹⁵

Another smaller study showed that 100% of children who received Menveo at 6 and 12 months of age produced an immune response against meningococcal C, W and Y after the 2nd dose.⁴⁶

Although Menveo is registered in a 2-dose schedule from 7 months of age, data from these clinical trials showed that the immune response in children who started vaccination at 6 months of age was similar.

97% of children aged 12–23 months who received Menveo developed a protective immune response to all 4 meningococcal serogroups after 2 doses.⁴⁴

2 large studies in adolescents showed good immunity after vaccination with Menveo.^22,57 Supporting studies in adolescents and adults also found that more than 80% of people developed an immune response to all 4 meningococcal serogroups.^22,48,129

Nimenrix (MenACWY-TT)

When Nimenrix was given in a 3-dose schedule at 2, 4 and 12 months of age in a clinical trial, more than 99% of children developed protection against all 4 meningococcal serogroups after completion of the course.²⁰

In another study of Nimenrix given at 6 and 15–18 months of age, 94% of children developed an immune response against all 4 meningococcal serogroups after the 1st dose at 6 months, and all but 1 out of 139 vaccinated subjects had a protective response to all 4 serogroups after the booster dose in the 2nd year of life.²¹ In another study, a 2-dose schedule of Nimenrix given at 9 and 12 months of age produced immune responses against all 4 serogroups in 98% of vaccinated infants after the 1st dose and in all children after the 2nd dose.¹⁹

1 dose of Nimenrix produces a strong immune response in children aged 12–23 months. More than 97% of children developed an immune response against all 4 serogroups (A, C, W and Y).^11,17,18,40

A large trial in adolescents showed that 85.4–97.4% of participants had a vaccine response following vaccination with Nimenrix, depending on the serogroup. Almost all participants had evidence of immunity against the 4 vaccine serogroups.⁴³ Other studies have also demonstrated good immune responses after vaccination with Nimenrix, either alone or with other vaccines.^23,41,42,130

NeisVac-C (MenC-TT)

Most clinical trials of NeisVac-C involved co-administration with other routine vaccinations. These trials demonstrate that NeisVac-C induces a good immune response against serogroup C.⁸⁰

Post-licensure data from the United Kingdom MenC vaccination program show that 1 dose in young children is 83–100% effective.^81,141 This program used a combination of MenC vaccines.

The Netherlands and Iceland used NeisVac-C exclusively in their MenC vaccination programs. Data from these countries showed falling rates of serogroup C cases among both vaccinated and unvaccinated people, and no vaccine failures among vaccinated people.^142,143

The population-wide use of NeisVac-C in national vaccination programs has resulted in marked reductions in serogroup C invasive meningococcal disease in the eligible age groups, including in Australia.^81,112,141 Although antibody levels wane after vaccination with meningococcal C conjugate vaccines,^144-146 current serogroup C meningococcal disease epidemiology in Australia suggests ongoing protection in age groups who were previously vaccinated.¹¹²

For all meningococcal vaccines, transport according to National vaccine storage guidelines: Strive for 5.¹²⁸ Store at +2°C to +8°C. Do not freeze. Protect from light.

MenACWY vaccines

MenQuadfi is supplied as a clear, colourless, sterile solution in a vial. It can be stored at temperatures up to 25°C for up to 72 hours.

Menveo must be reconstituted. Add the entire contents of the liquid MenCWY vial to the lyophilised MenA vial and shake vigorously until the powder completely dissolves. Use reconstituted vaccine as soon as practicable. If it must be stored, hold at +2°C to +8°C for no more than 24 hours.

Nimenrix must be reconstituted. Add the entire contents of the pre-filled syringe or ampoule of solvent to the vial and shake well until the powder completely dissolves. Use reconstituted vaccine promptly. Reconstituted vaccine is stable at temperatures up to 30°C for up to 8 hours.

MenB vaccines

Bexsero is supplied as a suspension for injection in a 1.0 mL (Type I glass) pre-filled syringe. A fine off-white deposit may form in the syringe after storage. Shake the vaccine well before use to form a homogeneous suspension.

Trumenba is supplied as a white suspension in a pre-filled syringe. Shake the vaccine vigorously to obtain a homogeneous white suspension. Do not use the vaccine if it cannot be resuspended.

MenC vaccines

NeisVac-C is supplied as a semi-opaque white to off-white suspension in a pre-filled syringe. Shake the vaccine thoroughly to obtain a homogeneous suspension.

Invasive meningococcal disease is a notifiable disease in all states and territories in Australia.

Prompt diagnosis and medical treatment of suspected cases of meningococcal disease are critical.

The Communicable Diseases Network Australia national guidelines for invasive meningococcal disease¹⁴⁸ have details about the management of cases and contacts.

Local and state and territory public health authorities can provide further advice about the public health management of meningococcal disease.

The local, state or territory public health authorities will decide whether vaccination is needed for:

• close contacts of a meningococcal disease case, such as people with household or household-like contact
• people in an institutional or community setting during a meningococcal disease outbreak

These decisions will be made according to the national guidelines.¹⁴⁸

The product information for all meningococcal vaccines states that there are no data on the use of these vaccines in lactating women. The Australian Technical Advisory Group on Immunisation (ATAGI) recommends that breastfeeding women can receive meningococcal vaccines.

MenQuadfi

The product information for MenQuadfi states that a single booster dose can be given to adolescents and adults who have been primed with meningococcal vaccine at least 4 years prior.

ATAGI recommends that people of all ages with ongoing increased risk of invasive meningococcal disease can receive booster doses:

• for people ≤6 years of age when they finished the primary course — 3 years after completing the primary schedule, then every 5 years after that
• for people ≥7 years of age when they finished the primary course — every 5 years after completing the primary schedule

Menveo

The product information for Menveo states that the vaccine is for use in people aged ≥2 months. ATAGI recommends that the vaccine can be given to people aged ≥6 weeks.

MenQuadfi, Menveo and Nimenrix

The product information for MenQuadfi, Menveo and Nimenrix state that vaccine should be administered as a single dose to people aged ≥2 years. 

ATAGI recommends that these vaccines can be given in a 2- or 3-dose primary schedule to people aged ≥2 years who are at increased risk of invasive meningococcal disease according to Table. Recommendations for MenACWY vaccine for people with a specified medical condition that increases their risk of invasive meningococcal disease.

Bexsero

The product information for Bexsero states that this vaccine is for use in people aged ≥2 months. ATAGI recommends that this vaccine can be given to people aged ≥6 weeks.

The product information for Bexsero refers to the final dose of the primary schedule in infants aged 2–11 months as a booster dose. 

The Australian Immunisation Handbook refers to the final dose of the primary schedule for infants aged 2–11 months as a 3rd dose. 

The product information for Bexsero states that for infants aged 2–5 months the 3rd (referred to as a booster dose) should be given in the second year of life (age 12 months or later) with an interval of at least 6 months between the primary vaccination series and the 3rd dose. 

ATAGI recommends that infants aged 6 weeks to 5 months should receive the 3rd dose at age 12 months or 8 weeks after the 2nd dose, whichever is later.

The product information for Bexsero states that for all children aged 12–23 months a booster dose is recommended with an interval of 12–23 months between the primary series and booster dose.

ATAGI recommends that for children aged ≤6 years, only children with specified medical conditions that increase the risk of invasive meningococcal disease should receive a single booster dose 3 years after completing the primary schedule. A booster dose is not recommended for people at standard background risk of invasive meningococcal disease.

The product information for Bexsero states that children aged 2–10 years at the start of the vaccine course should receive 2 primary doses, with an interval not less than 1 month between doses.

ATAGI recommends that children aged 2–10 years at the start of the vaccine course should receive 2 primary doses, with an interval not less than 8 weeks between doses.

The product information for Bexsero states that adolescents and adults aged ≥11 years at the start of the vaccine course should receive 2 primary doses, with an interval not less than 1 month between doses.

ATAGI recommends that adolescents and adults aged ≥11 years at the start of the vaccine course should receive 2 primary doses, with an interval not less than 8 weeks between doses.

Trumenba

The product information for Trumenba states that people aged ≥10 years with a specified medical condition associated with increased risk of meningococcal disease should receive 2 doses, at least 1 month apart, followed by a 3rd dose at least 4 months after the 2nd dose.

ATAGI recommends that people aged ≥10 years with a specified medical condition associated with increased risk of meningococcal disease should receive 2 doses, at least 1 month apart, followed by a 3rd dose at least 6 months after the 1st dose.

The product information for Trumenba states that this vaccine should be administered as a 2-dose primary schedule or a 3-dose primary schedule for individuals at increased risk.

ATAGI recommends that people with specified medical conditions and laboratory workers who are at occupational risk of exposure to Neisseria meningitides and have completed the primary series of Trumenba should receive a single booster dose of Trumenba.

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